What is Hyperbaric Treatment of Radiation Proctitis?
Radiation therapy, a treatment for different types of cancers like ovarian, uterine, cervical, prostate, bladder, and rectal cancers, is regularly applied to the pelvic area. Although this procedure can potentially harm the digestive system, it is considered valuable in fighting cancer. Hyperbaric oxygen therapy is a treatment that can help deal with this challenging side effect of radiation therapy.
What Causes Hyperbaric Treatment of Radiation Proctitis?
Radiation proctitis is when the lower parts of the colon get damaged, a side effect often seen after therapeutic radiation treatment. It’s a type of soft tissue damage that happens when there aren’t enough small blood vessels in the affected tissue. This is thought to be due to a condition called endarteritis, caused by radiation, that leads to the progressive closure of these small blood vessels.
As a result, the tissue doesn’t receive the blood it needs (chronic mucosal ischemia), causing the tissue underneath the surface (submucosal) to harden and tighten (fibrosis), the surface (epithelial) tissue to shrink (atrophy), and new fragile blood vessels to form (telangiectasia).
This can occur anywhere from 6 months to years after the body has been exposed to radiation.
Risk Factors and Frequency for Hyperbaric Treatment of Radiation Proctitis
Chronic radiation proctitis, a condition that can develop after radiation treatment for pelvic cancer, affects about 1% to 5% of patients. This happens when the radiation dose exceeds 5000 cGy. Some reports even suggest that the incidence rate may be as high as 10%.
Signs and Symptoms of Hyperbaric Treatment of Radiation Proctitis
Signs and symptoms of this condition may include:
- Bleeding from the rectum
- Mucus discharge
- Diarrhea
- Feeling of constant need to pass stool
- Inability to control bowel movements
The individual’s medical history should mention any radiation therapy received. It’s worth noting, radiation proctitis (inflammation of the rectum due to radiation) is unusual if the received dosage was less than 5000 cGy.
During the physical examination, the doctor might find:
- A perirectal fistula (an abnormal connection between the rectum and the skin)
- Anal ulceration (sores in the anal area)
- A rectum with symptoms of fibrosis (stiffening or scarring), along with mucus and blood
Testing for Hyperbaric Treatment of Radiation Proctitis
Your doctor will need to consider your previous medical history when checking for any signs of cancer returning. There are several ways they can do this:
1. Digital rectal examination: This is a simple procedure where the doctor inserts a gloved and lubricated finger into the rectum to feel for any abnormalities.
2. Proctoscopic examination: A proctoscope is an instrument with a light and a small camera that’s used to examine the inside of the rectum.
3. Colonoscopy: In this procedure, a long, flexible tube called a colonoscope is inserted into the rectum to check not only for cancer but also inflammation and ulceration inside the large intestine. This test is important to rule out cancer completely.
Even though biopsies are usually useful for diagnoses, they usually aren’t recommended in this case. A biopsy involves taking a small sample of tissue for examination, but doing one could damage the rectal wall and cause severe damage that leads to tissue death (necrosis) and abnormal connections (fistulas). Thus, doctors typically try to avoid this procedure to prevent these risks.
Treatment Options for Hyperbaric Treatment of Radiation Proctitis
The American Society of Colon and Rectal Surgeons have released guidelines for treating an ongoing condition called chronic radiation proctitis. Radiation proctitis is inflammation and damage to the lower part of the colon from radiation therapy. One of their top recommendations is a treatment called hyperbaric oxygen therapy. This therapy involves breathing pure oxygen in a pressurized room or tube and it’s known to be effective in reducing bleeding in patients with this condition.
There’s good reason to believe that hyperbaric oxygen therapy works by enhancing the amount of oxygen in the tissue in the long run, which in turn helps form new blood vessels. It also aids in promoting the formation of surface skin cells and collagen – a key building block of the body’s tissue. Most patients require between 30 to 40 treatments for the inflammation and damage from radiation to heal. This treatment is generally well accepted by patients, with more than 85% of them showing good results. For about 89% of the patients, it not only provides relief from the symptoms but maintains the improvement for around 6 to 12 months after the treatment.
It’s also worthwhile to note that hyperbaric oxygen therapy can be used in conjunction with other treatments, such as sucralfate retention enemas – a type of treatment where liquid medication is inserted into the rectum, 5-aminosalicylic acid derivatives – a class of drugs used to reduce inflammation, probiotics – helpful bacteria that are good for your health, antioxidants – substances that can prevent cell damage, antibiotics – medicines that help stop infections, and endoscopic argon beam plasma – a procedure that uses electric current to control bleeding in the rectum. Sucralfate enemas are very effective, inexpensive and well-accepted by patients, so they might be an excellent first choice for treatment. Hyperbaric oxygen therapy can be implemented along with these therapies, or as an alternative if the other treatments don’t work.
Nevertheless, bowel surgeries, which may sometimes be necessary for this condition, come with a high risk of complications – more than 70% in some reports. Including hyperbaric oxygen therapy before surgical treatment can significantly cut down the risk of complications and increase the chances of a successful outcome.
What else can Hyperbaric Treatment of Radiation Proctitis be?
Doctors need to rule out the possibility of cancer returning when they are examining a patient. Just looking at the symptoms may not be enough to distinguish between radiation proctitis, a side effect of raditation therapy, and more serious diseases. In a study involving 171 patients who experienced rectal bleeding after radiation treatment, radiation proctitis was diagnosed in 141 cases. However, the researchers also identified other conditions in 95 patients, including 8 cases of cancer and 9 cases of high-risk adenomas, which are abnormal growths that can become cancerous.
What to expect with Hyperbaric Treatment of Radiation Proctitis
A trial involving a specific method where participants were randomly selected, experimentation was controlled, and neither the participants nor the experimenters knew who belonged to the control group, showed significant improvement in the treatment of radiation proctitis using hyperbaric oxygen. Radiation proctitis is a condition where there is inflammation and damage to the lower part of the colon after receiving radiation therapy.
In studies looking back at patient outcomes, it’s been seen that complete stopping of bleeding and sense of immediate need to empty the bowel was achieved in about half the patients. An Australian study claimed a high success rate of 95% for the use of hyperbaric oxygen therapy. This therapy involves breathing in pure oxygen in a pressurized room or tube. This kind of therapy is known to increase the level of oxygen in your blood and help fight bacteria, stimulate the release of substances that promote healing.
Possible Complications When Diagnosed with Hyperbaric Treatment of Radiation Proctitis
Hyperbaric oxygen therapy is generally a safe treatment. However, some patients may experience minor ear trauma due to changes in pressure. Less common side effects include seizures due to too much oxygen, short-term nearsightedness, and formation of cataracts, although these are rare.
People with severe lung disorders or weak left cardiac ventricles may face more serious problems like lung injury due to pressure or sudden accumulation of fluid in the lungs.
Certain situations make hyperbaric therapy a bad choice. These include recent use of specific drugs like doxorubicin or bleomycin, feelings of fear in small or closed spaces (claustrophobia), epilepsy, serious lung condition especially with blebs, and having certain types of implanted devices.
Possible Side Effects of Hyperbaric Oxygen Therapy and Constraints:
- Minor ear trauma
- Seizures due to excess oxygen
- Short-term nearsightedness
- Rarely, cataracts
- In people with severe lung problems or a weak left ventricle, lung injury due to pressure or sudden accumulation of fluid in the lungs
- Top situations making hyperbaric therapy a bad choice: recent use of doxorubicin or bleomycin, claustrophobia, epilepsy, severe lung condition especially with blebs, possession of certain implanted devices
Preventing Hyperbaric Treatment of Radiation Proctitis
After receiving treatment for cancer, it’s crucial for patients to understand that they may experience certain side effects due to radiation, such as radiation proctitis – an inflammation of the rectum caused by radiotherapy. It’s important to identify and address these symptoms as early as possible, as quick intervention can potentially prevent the need for more invasive treatments later on.
A specific treatment option known as hyperbaric oxygen therapy may be recommended. Despite being a bit time-consuming, this therapy, which involves breathing pure oxygen in a pressurised room or tube, is generally well-tolerated, poses little risk, and can produce positive results for the patient. Always stay in conversation with your healthcare provider to ensure the best approach to your post-treatment care.